CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $122
Cash Discount Price: $108
vs. Medicare Baseline: 3.77x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Memorial Hospital is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.77x the Medicare baseline. Located in 1454 N County Road 2050 E, Carthage, IL.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $108 (333%)

Insurance Median: $122 (377%)

Cash: $108 (333% of Medicare)

Ins. Median: $122 (377% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 377% of the Medicare baseline (a markup of 277%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$38 - $135	117%
Blue Cross Blue Shield	$38 - $135	117%
Cigna	$38 - $135	117%
Health Alliance	$38 - $135	117%
Humana	$38 - $135	117%
Meridian	$38 - $135	117%
Molina	$38 - $135	117%
UnitedHealthcare	$38 - $135	117%
Consociate	$115 - $135	355%
Healthlink	$115 - $135	355%
Private Healthcare Systems	$115	355%
Integrated Health Plan	$119	367%
First Health Network	$120 - $135	370%
Health Dynamics	$122	377%
Health Payors Org	$122	377%
Iowa Health Solutions	$122	377%
Multiplan	$122	377%
Preferred Plan Inc	$122	377%
Three Rivers Provider Network	$122	377%
Health First Network	$123	380%
Pponext	$123	380%
Corvel	$128	395%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $108.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.